Perfectly Reasonable (16 page)

Chapter 35

Margo turned to go and then stopped. “Gwen?”

Anita nodded and smiled. “My sister.” She laughed. “I’m still wrapping my tongue around that. I’ve known I had a sister for a few years, but we’ve only connected recently.”

Margo felt a weight lift from her shoulders. Anita knew about Gwen.

Later that night, lying in bed, Margo thought about Trace’s mom. There was a woman who was generous and kind.
She
would have made an excellent doctor. Trace was lucky, and if he had half of his mom’s grace and goodness, he’d be fine.

Rose had told Anita about Gwen shortly after Trace’s birth. Anita had given a crooked smile. She had been sworn to secrecy, had to dampen her fierce curiosity and longing to meet Gwen, unless Trace needed an organ transplant. Jeez. But when her father died and Gwen was mentioned in the will, she had tracked her down. Anita and Gwen now shared a close bond, like they’d known each other forever.

Go figure. The route was a little circuitous, but the destination the same.

The ache of guilt in Margo’s chest eased a bit. It was a start, but would she ever feel like a doctor? Would the inside ever match the outward façade?

She sighed, rolled over onto her side, and hugged her pillow.

She knew the stuff. That was the frustrating part.

She could rattle off the latest research and create a decent differential. Common things were common. She’d memorized every management algorithm known to medicine.

And it hadn’t helped. Patients didn’t present with the common. They were all over the map. Where was the pattern? Where was the branch on the algorithm for all the ‘what ifs?’

The simple bladder infection in the patient with only one kidney. The diabetic with gangrene in his toe who refuses the amputation. The patient prepped and ready for surgery who has a cardiac arrest and dies.

Where was the branch on the algorithm for that? There was no branch. It was a scary leap off the branch into
I hope to hell I’m right
.

She rolled onto her back, stared at the ceiling, and sighed deeply.

How could she do it? There was so much uncertainty. There was so much more.

Which was what a residency was for, she thought as she hugged the pillow closer. And look at Clarisse. She’d have at least one patient eager to see her.

She drew the comforter up around her, tucking it under her chin. In the dim light, she caught a glimpse of the painting hanging on the wall. It was one of the few of her own gracing her apartment, and painting it hadn’t really been a straight path either. It had started out as a simple white winter landscape and morphed into an autumn vista with rich burnt yellow and orange against a shimmering blue lake. The white wouldn’t stick.

That was art. It was unpredictable. You could follow what felt right and go with it. Something better usually came from it. In the end, she’d hung the painting in her bedroom because she loved waking up to the vibrant colors and the season of change within the constant of nature that it represented.

Art. She had learned to accept unpredictability in painting. It was fundamental to creativity.

Why was it so hard to accept the unpredictability in medicine? She had the science of medicine down pat. Now she had to adjust to the art. Patients weren’t going to come in tidy little packages following preset algorithms. They were going to be unique. She had to adjust and figure out what was best, even if it meant coloring outside the lines or thinking outside the box. No matter how uncomfortable it felt for her, something better might come from it.

A burning pain flared in her gut.
If she was going to revisit her medical degree, she should also get stocks in antacids.

Was it worthwhile getting up and getting something for the pain or should she try to sleep it off? Margo glanced at the clock. Just after midnight, already Saturday. Another weekend and halfway through March.

Margo sat up, wide-awake. Shit. March fourteenth was her mother’s birthday. She should have called her. They weren’t best friends by any stretch of the imagination, but they never missed a birthday.

What time would it be there? Her mom was three hours behind. 9 p.m. Not too late.

Margo threw back the covers and turned on the bedside light. She grabbed a big sweater, slipped her arms in, and wrapped it around her. She pulled on thick fleece socks, and turning lights on as she went, padded into the living room. She picked up her phone, settled into the sofa, and with a fortifying breath, dialed her mom’s number.

“Hello?”

Margo’s heart pulled at the sound of her mom’s voice. “Mom. Happy Birthday.”

“Margo,” her mom said softly. “You called.”

Margo felt a lump gather in her throat. A gauge of her stress level. Her mother hadn’t made her sentimental in over three years.

“I wanted to wish you Happy Birthday.”

“Well that’s lovely. It’s lovely that you called. Thank you.”

That was a first. A bit strange. “Is everything okay?” Margo asked.

“Of course, dear. It’s late for you, and I didn’t think you’d call. I hear you’re having quite the icy winter.”

The weather. The weather was safe.

“Yeah, it’s been cold. But hopefully we’re at the end of it now. How about you? Is your garden blooming already?”

She listened to her mother’s voice, stronger now as she chatted about the familiar. The crocuses and the tulips blooming, the cherry blossoms starting.

“How are things with you?” her mother asked, finally.

Margo never knew if her mother really wanted to know or if she asked out of politeness. “Good. Things are good. Work is busy.”

“Well, that’s good. I figured you were busy. I tried to call last week, but I didn’t get through.”

Margo was taken aback. She tried to call? “Really? I missed that. Did you leave a message?”

“No, no. It wasn’t urgent. I had a medical question. I know you don’t like to talk about medicine, but . . .”

“Mom.”

“Well, I didn’t like to ask,” her mom said defensively. “Whenever I mention something about medicine, it seems to upset you.”

Margo shook her head. “Mom, you hardly took an interest when I was going through school. I thought you didn’t want me to talk about it. I thought it made you mad.”

Her mother was silent.

“Mom?”

“Oh, Margo,” her mother said, her voice shaking. “I wasn’t mad.” Margo heard her sigh through the phone. “I wasn’t mad. I was sad.”

“Sad? Why?”

“I was worried, especially when you were accepted. Medical school is so expensive. I didn’t have that kind of money. When your dad died, it was all I could do to keep a roof over our head and food on the table. There was no room for extras. You were only two years away from finishing your degree, and I had just enough saved for that. I couldn’t afford a medical degree.”

“But Mom, I didn’t ask you to help pay for it.”

“I know. But I wanted to. I thought I should.”

Margo scoffed impatiently.

“It seemed like such a pipe dream. Medical school. You’d have to work so hard. You were already a talented artist. Why put yourself through that?” her mother added.

“You never said any of this to me,” Margo said.

“You were so excited. I couldn’t.”

“I thought you were mad. I didn’t understand why.”

“I’m sorry, Margo. I truly am. Here I was, worried about how hard it would be for you, and I’ve only made it harder. You never once asked for money,” she said, censure in her voice.

“You didn’t have the money to lend. I knew that. I didn’t expect you to.”

“I can’t tell you how proud I am of you,” her mother said slowly. “M.D. Gold medal.”

Margo was silent. Her eyes filled at the words she hadn’t heard before.

“Talented artist. Smart businesswoman. I was at lunch with some friends last week. I mentioned you, and I was told that one of your paintings is hanging in the lobby of the Heritage House. The Heritage House, Margo. Did you know that?”

Margo laughed. “Yeah, I knew.”

“Why didn’t you tell me?”

“There’s one at Top Flight, too.”

“I’m writing it down. I’ll have to make a trip there, as well.”

“I can send you a picture,” Margo offered.

“No. I want to see the real thing. June didn’t know about that one.”

Margo shifted and tucked her legs up underneath her. “Did you get the medical question answered? The one you were calling about?”

“Oh, that was for June, too. She had a double mastectomy five years ago. Her mother had breast cancer at forty, and June has that cancer gene they talk about.”

“BRAC 1 or 2.”

“Yes, something like that. Anyway, they found a lump in her chest wall.”

“Oh, no.”

“Yes. I was calling to ask if it could be cancer. I mean, I thought, how could it? They removed the whole breast. There was nothing left to get cancer in.”

“Unfortunately, you can get cancer in the chest wall, even after a mastectomy. It’s not common, but possible.”

“Oh.” Her mother sighed. “Poor June. She goes this week for more tests. I hope it’s not.”

“I hope so too, Mom. There are other possibilities. It may just be a cyst in her skin or extra tissue in the scar.”

“I’ll let her know,” her mother said. “Even the slightest bit of reassurance will help her. She’s so worried, and her doctor didn’t give her much information. You really don’t mind me asking? I thought medicine was taboo.”

“No, it’s fine. It was taboo because I thought it upset you.”

“Oh. I thought it was taboo because you dropped out.”

“I didn’t drop out, Mom. I’m taking a year off to figure out if I want to make a career out of it.”

“Or paint?”

“Yeah.”

“Why don’t you do both? My doctor only works part-time. I have to wait a week to get an appointment, for goodness sake. You could do that.”

Margo considered. “I suppose I could. I’m not sure if I like medicine enough.”

“If you’re good enough,” her mother corrected.

“Well, yes, I guess,” Margo said with a sigh.

“Margo, you earned the gold medal. You’re good enough. You have to start believing in yourself. You were always the one your friends turned to when they needed advice. You’ll make a wonderful doctor. Don’t stop for the wrong reasons.” Her mother paused. “I wish I could give you a hug.”

“I wish you could too, Mom,” Margo said huskily.

“For my birthday present, I’d like to come and visit you.” Her mother paused. “What’s going on with June got me thinking, and June said she would travel with me. She knows a bed and breakfast where we could stay. We can do the touristy things while you’re working, and we could have dinner with you. Spend some time with you. What do you think?”

Margo smiled. “I think that’s a wonderful idea.”

“We’ll wait until the weather is better. We don’t want to travel in an ice storm. And after June’s tests, of course. But we’ll count on her getting a clean bill of health, and then we’ll book our tickets.”

“I’d like that, Mom. It’s been a long time. I can send some money for you.”

Her mother was silent. “That’s not necessary, dear, but thank you for the lovely offer.” Her voice shook. She cleared her throat.

“Happy Birthday, Mom.”

“Thanks. We’ll see you soon.”

Margo hung up the phone. She wrapped the sweater tighter and set the phone on the table. After all these years, her mother wanted to visit. Her mother was proud of her. A warm feeling washed over her, and she smiled. Her mother was proud of her.

Margo leaned back against the sofa. Could she do it? Finish medicine? Learn the art? She wouldn’t have to give up painting completely. Maybe she could keep what makes her happy, continue to do what fulfills her, and find a balance.

Margo reached over and shut off the light. She made her way to her bedroom and snuggled under the covers.

Her mom was proud of her.

She wiped the tears from her eyes.

Chapter 36

Trace looked around the room at the seven other medical school hopefuls who, like him, had drawn the group interview first.

He hadn’t seen so many people dressed in black since his grandfather’s funeral. All of them had some variation of a black jacket and white shirt with conservative dark ties for the men. Except for pink bow tie dude. Seriously?

They sat at a round table in a tight room. The gray-tinted window, filling one wall, reflected like a mirror. They weren’t told they were being observed, but hello. Of course, they were. A few obviously missed that memo. No smiles. No eye contact. They said nothing.

They needed Margo’s coaching.

They started with cursory introductions. He half listened, his mind busy planning what to say. He got his name right – so far, so good.

Next up, they were given a topic to discuss. Doctor-assisted suicide. Jump right into controversy. The silence was painful.

“I think there are two sides of the coin to consider with assisted suicide,” Trace began, making eye contact with the ones who looked up. “Part of dying with dignity should include the right to choose to die. The elderly who have lived full lives and develop a debilitating illness, the terminally ill in severe pain.” He shrugged. “They should have the right to decide to die peacefully, when they choose. On the other hand, you have to consider the potential for abuse – the children who want the inheritance money, the family who can’t afford the care. Just as difficult would be the ones who are ill and have lost hope, like the patient who’s depressed or the patient with cancer pain, but who have the potential to recover. The question comes down to who should have the final say. I think that each case would have to be considered carefully to make sure the underlying motives are in the right place.”

“I completely disagree,” said Pink Bow Tie. “It should never be allowed, under any circumstances. A doctor’s role is to help people, not kill them.”

No one else spoke. Trace looked around. Should he jump in again? Margo said not to hog the floor, but Pink Bow Tie stared at him, his face set.

“It’s a difficult decision. What if the most helpful thing is to let them die as they wish?” Trace asked when no one else spoke up.

“It’s not right,” insisted Pink Bow Tie.

“I think it should be allowed in special cases,” said a redhead. All the heads swiveled to her, and she blushed and looked down.

Trace almost jumped in, but Pink Bow Tie couldn’t let it go.

And so it continued for another fifty minutes. They debated whether experimental drugs should be released to fight the Ebola virus outbreak, discussed the pros and cons of legalizing marijuana – surprisingly strong views on that one, thought Trace – and what should be done for doctors who were addicted to drugs. Trace suppressed a grin. Interesting choice of topic on the heels of legalizing marijuana.

As they wrapped up, Trace considered the candidates. Pink Bow Tie needed to take it down a notch. Redhead needed to pump the brakes. Speak up more. And not let Pink Bow Tie railroad her.

He thought he did okay. Tried to chip in, take a stand and not sit on the fence, listened, commented. If they marked on eye contact and e-quotient, he should be fine.

Trace had a half-hour break to eat lunch, which the school provided. It wasn’t a bad spread, but there weren’t many hearty appetites.

He stood off to one side and ate a roast chicken and cheese sub. Carefully. Last thing he needed was a grease stain on his tie. As he finished, he caught a glimpse of a familiar face. “Russ, how’s it going?” Trace asked, stretching out his hand.

Russ leaned over and shook it. “Not bad, man. Not bad. Haven’t seen you for a while. You’re not hanging in the Sci-Fi lounge any more?”

Trace grinned. Those were the days. “On to bigger and better things.”

“More comfortable chairs in the math department?” Russ asked.

“Absolutely. And highly caffeinated drinks in the drink machine.”

“How do they keep that a secret?”

“We write a complicated math equation on the exterior. Drives mere mortals away.”

Russ laughed. “I would be among them. Running, not walking.” He crumpled up the paper wrapper from his sub and tossed it in the trash. “So you’re thinking of medicine. They could use more math brains like you,” Russ said.

“I’m hoping. Are you interviewing anywhere else?”

“Brighton last week and U of S in two weeks’ time.”

Trace nodded. “Nice. Congrats. How does this compare to Brighton?”

“They’re all about the same. Smile, nod, try to keep the ‘how the hell is this relevant’ look off my face. Play the game.”

Trace grinned. Russ would make a great doctor. “Good luck with it.”

An elderly woman with a clipboard walked into the room and called their names to begin the next round.

Russ reached out to shake Trace’s hand. “Hopefully I’ll see you again on the first day of classes.”

Trace shook his hand. “Save me a seat in the front row.”

They followed the woman out into the hallway. Russ was shepherded to the personal interview, and Trace followed the group for the MMI. There were five stations, each ten minutes long, with two minutes to read the scenario and eight minutes to interact with an actor patient.

Trace stood outside the door of the first room and read the instructions.

You have one dose of a life-saving drug and two patients who need it. One patient is the two-year-old child of a physician and her husband. The second patient is a sixty-seven-year-old scientist who developed the vaccine for HIV.

In the next eight minutes please initiate a discussion with your colleague about whom you will choose to treat.

Trace took a deep breath. Okay. Think. What would Margo want to know?

The practical stuff. Do both parties want it? Any other options? Could the child take a lower dose and they share it? Could they get more drug from another country? How sick are they? His heart rate slowed as he came up with reasonable ideas.

When the chime sounded for him to enter the room, he walked in with a smile and introduced himself.

And the fun began.

He asked his practical questions and when the chime ended the interview, he thanked the ‘colleague’ and wondered how the hell anyone would make a decision like that. Both patients needed and wanted it, there were no other options, and both should get it. There would be no good ending to that story. Set it aside, he told himself, hearing Margo’s voice. He did the best he could, and it’s done.

He walked over to the next room and read the scenario.

There are two parts to the next section. You will share your decision with the two patients involved. In the first interview you will speak to the mother of the two-year-old child, and in the second interview you will speak to the scientist. You may only give the drug to one patient. Each interview will be eight minutes long.

Holy shit. Trace felt sweat run down his back between his shoulder blades.

He hadn’t made a decision. He had gathered information. How could he choose to end someone’s life? And tell them to their face?

Thirty seconds. Shit. Who gets it?

When the chime sounded, he wiped damp palms on his pants and walked into the room to greet ‘the mother.’

The next sixteen minutes were the longest of his life. His mouth was so dry, he stumbled and stuttered. He felt the sweat on his brow and feared it might drip off his chin. It got worse when the patient looked sympathetic. He was pretty sure that wasn’t a good sign. That’s when he perspired through his suit jacket.

Shit. Guess he could kiss medicine good-bye. That was dismal.

He floated through the last two scenarios. Couldn’t even recall what he said, what he did.

When it was over, he sighed deeply. He needed a drink. Water and sugar for now. Something stronger later.

Next up was the personal interview.

Put it behind you, Trace. He looked around at the other devastated expressions and took some consolation that it wasn’t just him. They all sucked. They must have put all the B-list players in the same pool.

Move on
, he told himself.

Focus on what’s next.

A doctor and a second-year medical student sat across from him. They introduced themselves briefly and then turned to him.

“Tell us a bit about yourself,” the doctor said, with a smile.

Thank you, Margo.

Trace talked briefly about his undergrad degree, graduate work, his tutoring, the research he was doing, and his experience volunteering at Breaking Bread. “I’ve organized a ball hockey tournament to raise money for Breaking Bread. Three weekends from now. There was a lot of interest, and we had to cap it at sixteen teams. But it would be nice if it became an annual event and grew,” Trace finished.

The medical student grinned. “I’ll be there. We entered a team.”

Trace smiled. “No kidding? That’s great.” He nodded. Small break there.

The doctor was very interested in Trace’s research. She had a project of her own on the go and asked Trace about multivariate analysis of variance versus analysis of variance with Tukey’s HSD post-hoc testing. The great thing about knowing the ins and outs of statistical analysis was simplifying it. And generally nobody’s life was at stake.

At the end of the interview, Trace smiled, shook their hands, and thanked them.

Done and done. At least the interview went better than the MMIs. So if he wasn’t totally sunk with his MMI score, he may have a chance.

He shook his head. Was medicine really like that? Did doctors have to make those tough decisions? He hadn’t thought it would come up that often, but really, organ donation, blood transfusions, limited drugs, all the extra care people had to pay for, it probably wasn’t as rare as he imagined.

No wonder Margo had a hard time. She’d care too much. She had such goodness in her, was beautiful to the core. It would break her heart to make a decision like that. And break her spirit.

And who would she talk to about it? Another doctor, probably. She’d need someone with a similar perspective.

He’d be useless. He couldn’t even get through the interview. Hell, with actors. He was sweating bullets, and it wasn’t even real.

Thank goodness she chose painting. Because if she ever decided to go back to medicine, that would be the end of any relationship with him. She’d need a doctor.

He owed Margo a bucketload of thanks and an apology. If only he could rewind the clock and take back what he’d said to her when Ottie was sick. Throw a little empathy out there.

How could he make it up to her? His body stirred at the thought of another Friday night.

He should probably start with an apology.